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Mobility Toolkit

Patient Mobility Data Assessment Center.

Physicians and researchers will get a "mobility toolkit" for collecting and using objective outcome data on patient-performance based measures (PBMs), as part of a new project supported by the AO Strategy Fund. That toolkit—the goal of the Patient Mobility Data Assessment Center project led by AOTrauma North America Past Chair Stephen Sims, MD—will include a package of training materials, software and reports.

The project has its roots in the bioengineering department at Carolinas Medical Center in Charlotte, North Carolina (US), where Prof Richard Peindl began looking at head injury patients and elderly patients to assess their fall risk.

"They were in the early stages and had begun to develop an AO Mobility Cloud to store information like the usual problems with progression, but the lack of additional funding had somewhat stalled that project," said Sims, whose key collaborators in the Patient Mobility Data Assessment Center project include Peindl, along with AO Foundation Past President James Kellam, MD at the University of Texas Houston Health Science Center, and Rachel Seymour, Director of Clinical Research for Carolinas Medical Center.

"We were looking for a way to reinvigorate this project, and the AO Strategy Fund grant has helped," Sims said. "Our project may have been possible without this grant, but it would have been a much longer, slower process, and we would have been nowhere near where we are now in terms of progress."

The Patient Mobility Data Assessment Center project involves far more than developing a performance-based test for assessing patients' functional capabilities. Its four major components include:

Establishing and maintaining collaboration with the AO Patient Outcomes Center

Refining existing software to expand the potential of including additional tests and developing individualized reporting formats

Developing a training and delivery package to support implementation in a variety of settings and with a range of staff such as nurses, nurses' aides and research coordinators

Collaborating with AO Clinical Investigation and Documentation (AOCID) to develop research studies using the PBM technology in conjunction with patient-reported outcome measures (PROMs) in various orthopedic populations. As part of this component, a study will be developed in cooperation with AOCID to correlate PBM-derived kinematic variables with selected outcomes as currently evaluated. Resulting data can be correlated with patient variables like demographic and injury characteristics to get a fix on the relative impact on outcomes such as complications, readmissions and healing

The project is already revealing some observations during the first three months of data collection.

"For example, during a timed up and go (TUG) test, the patient can wear an inertial measurement unit (IMU)—half the size of a cell phone and strapped to the chest—and we can learn from the IMU what the patient’s body is doing," Sims explained. "Gait analysis is a big area, and you’d normally spend millions of dollars developing a high-tech gait analysis lab which would require trained personnel to run and maintain it. What we're doing is developing a mini gait analysis lab based on the collection of data from hundreds of control patients from a wide range of age groups."

As a result, the patient mobility tool kit can help clinicians analyze patients' gaits and accordingly direct physical therapy based on problems—or even tailor treatments based on comparisons with the collected data.

"The IMU technology exists everywhere, but no one ever really looked at it for this purpose. The Carolinas Medical Center bioengineering department customized IMUs and got them to do what we want them to do—and at an affordable cost," said Sims. "As a result gait analysis can be done by research analysts and we are developing training materials so that anyone could do it."

The mobility toolkit will serve patients by helping them get a feel for the progression of their recovery, physicians by giving them the ability to tailor their treatment recommendations, health care administrators charged with providing data to governmental or insurance agencies, and researchers requiring performance-based measurements.